UAB Hospital Emergency Department to screen patients for hepatitis C

UAB joins a CDC effort to reduce hepatitis C infection through a screening program in the emergency department.

The Emergency Department at the University of Alabama at Birmingham (UAB) Hospital will begin testing baby boomers for the hepatitis C virus (HCV) in August 2013. All patients born between 1945 and 1965 who present at the ED for any cause will be offered a blood test for HCV as part of their routine examination.

The testing is part of a Centers for Disease Control and Prevention (CDC) initiative designed to identify patients with HVC and get them into appropriate treatment. The CDC estimates that one-time testing of all Baby Boomers could detect 800,000 additional people with hepatitis C and save more than 120,000 lives because 75 percent of these infections are curable with new treatments.

“We anticipate screening between 8,000 and 12,000 Baby Boomers for HCV in 2013 and expect to identify between 260 to 400 new cases of HCV infection at UAB,” said James Galbraith, M.D., associate professor of emergency medicine and head of the UAB HIV and HCV screening programs. “The overall target is the approximate 3.2 million people in the United States who the CDC estimates have chronic hepatitis C virus infection — many of whom are unaware they are infected because they don’t look or feel sick.”

Hepatitis C is a contagious liver disease that ranges from a mild illness lasting a few weeks to a serious, lifelong illness that attacks the liver. It is spread primarily through contact with the blood of an infected person. Today, most people become infected with the virus by sharing needles or other equipment to inject drugs. Before 1992, when widespread screening of the blood supply began in the United States, hepatitis C also was commonly spread through blood transfusions and organ transplants.

The HCV screening program mirrors a similar ED-based program at UAB Hospital to screen for HIV, the virus responsible for AIDS. That program, which began in August 2011, screens for the presence of HIV in all willing adult patients ages 18-65 seeking treatment at the UAB Emergency Department. Of the more than 30,000 screened, Galbraith says the program has identified and referred to treatment more than 150 people who were HIV positive.

The CDC estimates that one-time testing of all Baby Boomers could detect 800,000 additional people with hepatitis C and save more than 120,000 lives because 75 percent of these infections are curable with new treatments.

Patients testing positive for HCV will be linked to appropriate antiviral treatment services through the UAB Liver Center, Liver Transplant Clinic and 1917 Liver Clinic. A linkage coordinator will also help positive HCV cases establish a primary care physician to maintain consistent health care throughout the progression of their disease. UAB Charity Care services will help patients with limited resources obtain appropriate medical care.

UAB ED nurse manager India Alford, RN, says the program will not disrupt patient care in the Emergency Department.

“Patients in the Baby Boom generation will be electronically identified at registration and the patient’s nursing provider will conduct a required HCV assessment,” Alford says. “During the brief three-item assessment, nursing providers will notify the individuals about the CDC’s recommendation and the screening will be available at no cost.”

Unless they refuse, an automated HCV antibody assay will be ordered for eligible patients unaware of their HCV status. Results of the HCV assay will be available within 30 minutes and delivered to patients prior to discharge.

“These day-to-day screening operations would not be possible without the dedicated support of the ED nursing and laboratory staff,” Galbraith says.